In recent years, it’s become fashionable to talk about mental health in more mainstream ways. Superstars like Jim Carrey, Carrie Fisher and Catherine Zeta-Jones have come out with personal stories of struggle, overcoming, and messages of hope and healing for the general public; most of their speeches and stories have even included endorsements of one form of treatment or another, one of which is almost always medication.
Robin Williams’ suicide, along with that of other high-profile people, has in some ways forced the mainstream to allow discussion about it, however selective (“depression” is fine, “schizophrenia” is still taboo, and any “personality disorder” is still “toxic”).
Now it’s “okay” to have depression. It’s “cool” to be anxious. It’s “normal” to “need” to cancel plans last minute or back out of commitments or not follow up or leave people hanging in the name of your personal “mental health.” Ultimately, mental health going mainstream, to rousing cheers and declarations of “small steps toward victory,” has led to a larger demand for the expansion of services since, as I wrote about last month, there isn’t anything in our culture, education system, or work lives that even acknowledges the importance of relational skills, let alone trains us on how to truly be there for each other.
The lip service that “we need each other,” the valid concern about the loneliness epidemic, the repetition from more and more people that “humans need connection” has not actually translated into anything that would concretely remedy that. Instead, it’s now mainstream to talk about your depression, encourage others to “be brave” and go to a therapist, suggest medication to others who may be struggling, too.
What has gone mainstream is the paradigm that mental illness is a real thing, that diagnosis is necessary to get treatment, and that the treatment is lifelong medication, years of talk therapy or, “in many cases, a helpful combination of both,” as the rhetoric goes. The cultural conversation about mental illness is not about mental health; it’s PR for the psychiatry and psychology industries, who are looking for ever more market share even as they dupe millions into believing they are real sciences.
Mainstream “mental-health advocates” endorse the biomedical model and the chemical imbalance theory as they sound the alarm for “underserved” communities, particularly poor, rural, and/or BIPOC communities. Their criticisms of the system amount to #therapysowhite or #therapysoableist or #therapysostraight—that is, members of marginalized groups cannot find therapists that look or think or feel like they do. That there is no mental-health parity in health insurance coverage. That medications are too expensive. That individual talk therapy has become a “middle-class white woman” thing when it should be available to all.
The mainstream conversation about mental health does not touch informed consent beyond individuals who talk about medication including the obligatory “I’m not a doctor, I do not offer medical advice” disclaimer. It does not allow for sustained conversations about “side” effects of medication; when someone does suggest that psych meds might not be the panacea industry would have us believe, they are instantly shut down and their valid concerns are labeled “medication shaming.” The range of conversation around medication in the mainstream is so narrow that it does not allow for nuanced discussion about what informed consent of the consumer means, that we are so far from it with almost any treatment on offer in the mental-health industry and how dangerous such lack is.
The mainstream conversation has not gotten beyond the listicles of “What Not to Say to Someone with Depression” or the debates about what personal designations are appropriate: “we say person with depression not depressed person because you are not your disease.” The mainstream permits talking about our feelings…so long as we do not actually ever feel them.
And what has all this clamoring for more services, more coverage, more “safe spaces” and trigger/content warnings, etc., gotten us? Less isolation and more connection? A stronger sense of true belonging and what we have to offer our communities? The experience of (rather than the intellectual assent to) actual community? Not even a little bit.
We Americans, especially white Americans, still think intensely painful levels of loneliness and isolation are totally normal. Almost 20% of my generation (the Millennials) say that have no close friends—and articles that cite what should be an alarming statistic give “resources” like the suicide hotline as remedies. That is unconscionable.
Not only are suicide hotlines not confidential, even as they claim they are. Not only are they often more alienating for people who call them. Not only do they excuse the pain they inflict on many people with claims that they help more people than they hurt—as if the people they hurt don’t matter.
But how in the world is directing people who report having no close friends to strangers on a phone who, by the way, have the power to send other strangers with guns to your house even if you do not disclose anything about your location an appropriate response? Even after several years of (selective) discussion about mental health in the mainstream, this is the best we can do?
Even after piles of evidence that the common (read: only) treatments recommended work only half the time, or work no better than placebo and have hideous side effects, mainstream mental-health advocacy has nothing better to offer than bracelets with semicolons on them and articles instructing readers on how to talk to your friend about “getting help” for their anxiety.
It continues to tout a stigmatizing and dangerous theory of “mental illness” in the name of “advocacy,” including caveats and excuses for why “some people” “need” involuntary treatment/their rights violated “for their own good.” Loneliness continues to rise. People continue for years to “just get through another day” without finding their purpose or their people.
The worst part about all this is that it normalizes suffering that could otherwise be alleviated. Hear me: I am not saying that all human suffering can be alleviated. Pretending that it can be is part of the violence of the mental-health industry. But the suffering caused by systemic injustices and structural oppression—racism, sexism, ableism, capitalism, etc.—could be alleviated by dismantling those systems.
Instead, the mental-health industry commits even more violence by blaming structural injustice and its attending (and totally predictable) suffering on the individual experiencing the damage of those systems and suffering for it. Mainstream mental-health conversation does not make mention of any of that, at least not in any sustained way that might make a difference.
It encourages people to “be open” about their depression, reminding them that they are not alone and that there is “no shame” in seeking therapy or taking meds. “We take medications for all the other organs in our body when stuff goes wrong—why should the brain be any different?” they say, without any acknowledgement that the brain is fundamentally different than “all the other organs,”(including the heart, which is also deceptively complicated).
The brain is the organ we know the least about; the more neuroscientists study it, the less they know. That alone should be enough reason to pause before dumping meds into it, but it isn’t enough for mainstream mental-health advocates.
Mainstream mental-health advocacy stops at “you are not alone.” What could be used to unite, connect, and organize people is instead a bumper-sticker slogan used to direct people to individual services, which reinforce their aloneness.
All of this is intentional; if “mental-illness” sufferers were to embody and act on what it truly means that they are not alone, they could take down the system. They could topple it by mass boycott. They could create their own systems that actually meet their self-defined needs and that render the current ones obsolete. They could truly connect with each other without the smokescreens of diagnosis, mediated interactions or the malaise of false pathologies and the shame that comes with them.
But they are being kept apart by the way our culture talks about mental health, champions “how far we’ve come” and continues to “treat” “mental illness” in exactly the same alienating, invasive, individualistic, and annihilating ways it always has.
Except now it’s worse because the damage isn’t as obvious and the mental-health community has been thrown a bone: “You all get to talk openly about it now. Some of the diagnoses anyway. Not the scary ones like schizophrenia or borderline. Those are violent and toxic, obviously. But hey, baby steps, right? Maybe someday you’ll be able to make jewelry and get viral tattoos about them, too!”
It is a classic misdirection, and it is not progress at all. It is expanding the market for the “services” and “treatments” that further the need for more “services” and “treatments,” leaving the suffering and isolation and alienation completely untouched.
I’m not saying we should or even can fix the mainstream conversation about mental illness (or about anything else, for that matter). But I’ve begun to see some alternative mental-health conversations starting to pick up some of the subtler versions of the mainstream conversations and I don’t want the non-mainstream folks getting co-opted.
One example is folks who claim to be alternative or radical (and thus safe for people who have been abused by the mainstream system) congratulating the “progress” mainstream culture has made in including mental health in the conversation. This muddies the waters and forms a confusing tie between material trying to be alternative and material that is firmly in the mainstream. At this point, trying to meet in the middle would likely dilute alternative discussions.
Another more worrying example of the blurring of the line between alternative and mainstream mental-health approaches is the slide toward “exceptionalism,” mostly found in professionals who claim to be alternative or radical (and who Mad in America has had on webinars and other presentations). It’s one thing for the head of the American Psychiatric Association to endorse medication. It’s quite another for someone who alternative outlets endorse as non-mainstream to do so. As in, “Well, sometimes medications are necessary” or “Involuntary hospitalization is last resort.”
Why do even “radical” professionals feel the need to reserve the right to chemically restrain or violate another human’s rights? Do they really think that these treatments that damage, harm, and terrify people are ever necessary?
I might be able to get on board with that if the argument were to include the clear acknowledgement that our current economic, social, political, and legal/criminal systems are what are causing the harm and that we as a society are wholly addicted to them. As long as we as a society insist on keeping our current systems and structures the way they are, then the “treatments” and “services” like involuntary commitment, forced medication, and impotent talk therapy are “necessary” for the system to survive and perpetuate itself.
But I don’t know how we can say that such barbarism is “necessary” for the individual, especially when we haven’t tried true community, offering education on relationship building and connection and true advocacy, which should look more like taking down harmful systems and less like listicles and charm bracelets.
Listicles and charm bracelets are harmful because they misdirect from the real issues. They cause people to believe progress is being made when it really isn’t. They reinforce, or at least are totally silent about, stigmatizing and inaccurate theories about “mental illness.” They give people a false sense of belonging that does not compel them to take consistent, sustained action on behalf of others and they forestall solidarity by channeling any energy available for that toward yet more consumerism, connection lite, and resolve to “just get by” rather than fight for real change.
It may be possible to change the mainstream conversation—after all, I remember the times when mental health was unmentionable in public, and I’m not that old. But I don’t know that that’s how best to use our energy anyway.
The choice between trying to change systems or creating new ones is, of course, as old as damaging systems and there are good arguments from every angle. What I hope I’ve done here is clarify the problem of mainstream mental-health talk so that the discussion about changing systems or creating new ones can take these issues into account, as well as to call out the slippery slopes I see appearing in various places by people that claim to be, and may generally want to be, truly alternative.
This is not about “us versus them” but about preserving the line between what we truly need and what the system needs, because there can be no real unity between them.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.